On a recent episode of And Just Like That…, Charlotte York (Kristin Davis) goes shopping for a special back-to-work outfit to mark her return to the gallery world. In the dressing room, she is confronted with the fact that, among the many things that have changed since she was last full-time, one is her figure. “I just need to lose the belly,” she says, smoothing her midsection, exasperated, as she looks in the mirror at home.
Charlotte is not alone. It s a feeling many women confront in their forties and fifties, when weight gain in the lower midsection becomes so common that it has earned a deeply unfortunate nickname: “meno belly.” (“Meno” because this type of weight gain is linked to the period around perimenopause and menopause.)
Menopause doesn’t necessarily cause weight gain, but it does alter fat distribution and body composition (the relation ratio of muscle to fat). “Decreasing estrogen and increasing follicle-stimulating hormone (FSH) lead to increases in total body fat, fat deposition around the midsection, and increased waist circumference,” says Somi Javaid, MD, an ob-gyn and founder of HerMD Health.
“Numerous studies highlight that perimenopause, independent of age, is associated with increased abdominal fat and reduced lean body mass,” adds Jennifer Garrison, PhD, co-founder of Femistry and director of the Global Consortium for Reproductive Longevity Equality. “In younger women, estrogen promotes fat deposits around the hips, but as estrogen declines during menopause, fat redistributes to the abdomen without necessarily altering weight, and at the same time muscle mass goes down with age, often replaced with fat.” But where fat accumulates in the body can portend how said fat impacts our overall health. “Lower abdominal fat is associated with an increased risk of diabetes, cardiovascular disease, high blood pressure, stroke, and respiratory problems,” says Javaid, adding that it also places extra pressure on lower extremity joints which can lead to mobility and arthritic issues.
While gaining fat in this area is almost inevitable, addressing it can feel impossible—a perception that is not an unreasonable one. “Belly fat is often considered more difficult to lose as it’s considered an ‘active fat,’ since, unlike some fatty tissue that simply sits dormant, it releases hormones that can have an impact on your health,” says Javaid. There are two types of fat cells, she adds, alpha and beta: beta respond better to fat-burning processes, while areas of concern like the midsection tend to carry more alpha cells, which are harder to get rid of.
One thing to focus on improving? Your sleep. Sleep deprivation, Garrison says, can show up in your midsection because of its impact on appetite-regulating hormones. “Sleep deprivation is associated with increased levels of ghrelin, which increase our appetite, and decreased levels of leptin, which help us feel full,” says Javaid. Decreased insulin sensitivity is another side effect of lack of sleep. “When we do not have good insulin sensitivity we release more insulin to drop our blood sugar levels, and when we clear the sugar from the bloodstream we store it as fat,” Javaid adds.
Certain diet adjustments, such as decreasing carbohydrates, increasing protein, avoiding trans fats, and minimizing alcohol, can all help. Javaid also has patients consider intermittent fasting, which reduces insulin levels—and, in turn, fat storage—or to try swapping their coffee for green tea, which is rich in the metabolism-boosting antioxidant epigallocatechin gallate (EGCG). While hormone therapy (HRT) may not be the right path for everyone, it is protective for your heart, brain, bones, and muscles—and, says Garrison, the overall data of its impact on curbing weight gain is also positive.
Regular exercise is essential not just to address your midsection but for healthy aging overall. Taylor J Langston, an ACE-certified personal trainer and sports nutrition specialist in New York, says that while any movement you can be consistent with is great, some kind of resistance or strength training (this includes weight-bearing activity) is a non-negotiable. “This type of exercise promotes improvement in bone density, balance, and hormone balance,” she adds. Langston says that planking is a great core-specific exercise, but that even big compound movements like back squats, deadlifts, and bench presses engage the core in a functional and dynamic way. “When it comes to strength training and body shape, the most important pieces are consistency and progressive overload (like lifting heavier over time),” she says.
Our posture also has an important link to our midsection. “Posture and spinal alignment definitely can affect the shape and strength of our stomachs,” says Langston. While for some, the position of their uterus might create a natural protrusion, the amount of time we collectively spend sitting does too. “Over time this positioning can create tight or shortened hip flexors, a forward head and neck position, and a weak core, elements which result in a ‘sway back’ posture with our stomachs pushing forward due to overextension in the lumbar,” says Langston. Some exercises to counteract this posture problem are stretching the quads, hip flexors, lumbar, and chest while strengthening the glutes, hamstrings, and core.
Eating healthy and remaining active throughout the menopause transition are vitally important, but so too is a certain amount of radical acceptance. Part of that acceptance is related to the impact gravity and time will inevitably have on our faces and hair and bodies. The dress that you wore and loved in your twenties may not fit anymore and, if it does, it likely hits very differently—which is, repeat after me, perfectly normal. And just like that, you embrace a bit of belly and you move on.
